RT Journal Article
SR Electronic
T1 Chest pain for coronary heart disease in general practice: clinical judgement and a clinical decision rule
JF British Journal of General Practice
JO Br J Gen Pract
FD British Journal of General Practice
SP e748
OP e753
DO 10.3399/bjgp15X687385
VO 65
IS 640
A1 Jörg Haasenritter
A1 Norbert Donner-Banzhoff
A1 Stefan Bösner
YR 2015
UL http://bjgp.org/content/65/640/e748.abstract
AB Background The Marburg Heart Score (MHS) is a simple, valid, and robust clinical decision rule assisting GPs in ruling out coronary heart disease (CHD) in patients presenting with chest pain.Aim To investigate whether using the rule adds to the GP’s clinical judgement.Design and setting A comparative diagnostic accuracy study was conducted using data from 832 consecutive patients with chest pain in general practice.Method Three diagnostic strategies were defined using the MHS: diagnosis based solely on the MHS; using the MHS as a triage test; and GP’s clinical judgement aided by the MHS. Their accuracy was compared with the GPs’ unaided clinical judgement.Results Sensitivity and specificity of the GPs’ unaided clinical judgement was 82.9% (95% confidence interval [CI] = 72.4 to 89.9) and 61.0% (95% CI = 56.7 to 65.2), respectively. In comparison, the sensitivity of the MHS was higher (difference 8.5%, 95% CI = −2.4 to 19.6) and the specificity was similar (difference −0.4%, 95% CI = −5.3 to 4.5); the sensitivity of the triage was similar (difference −1.5%, 95% CI = −9.8 to 7.0) and the specificity was higher (difference 11.6%, 95% CI = 7.8 to 15.4); and both the sensitivity and specificity of the aided clinical judgement were higher (difference 8.0%, 95% CI = −6.9 to 23.0 and 5.8%, 95% CI = −1.6 to 13.2, respectively).Conclusion Using the Marburg Heart Score for initial triage can improve the clinical diagnosis of CHD in general practice.